Ask More: The Power of Questions to Open Doors, Uncover Solutions, and Spark Change pdfdrive com

Connect symptoms and specifics. Start with big, broad, what’s-the-problem
questions and then narrow down, zero in. Get past the generic to identify the
symptoms and describe related observations in detail.
Ask for the bad. Don’t duck the issues or avert your eyes. Ask direct questions in
search of direct answers. It may get ugly, but if you want to fix a problem, you
have to acknowledge it to deal with it.
Study history. Look back. Ask about similar experiences, events, and patterns.
They provide a baseline. Look for similarities to other situations.
Ask again. The mere existence of a problem means there is something unknown
or unanticipated. To be sure you’re on solid ground, ask several times and
several sources. Confirm and corroborate.
Challenge the expert. We rely on experts to diagnose our disease. But that
doesn’t mean they’re right or that they’re off the hook in explaining what’s
going on. Before you accept a diagnosis, ask what it is, what it means, and where
it’s coming from. And reserve the right to get another opinion.
“Miss Nosy”
The first step in diagnostic questioning involves knowing what you’re dealing
with. Teresa Gardner is an expert at that. She’s been celebrated by her peers,
which is how I heard about her and tracked her down, and she’s been profiled on
national television. Fearless, tireless and endlessly resourceful, Teresa works in
one of the most impoverished parts of America.
A nurse practitioner who makes her rounds through the hills and hollows of
the Appalachian Mountains in southwestern Virginia, Teresa deals with what she

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calls “human train wrecks.” Many of the people here are poor and chronically ill.
They lack access to jobs and healthcare. Unemployment rates in many areas are
twice or more the national average. Many eat poorly, get inadequate exercise,
and neglect themselves in the scramble to make ends meet.
“It’s an area of desperate need. But the people here are such good people,”
Teresa told me. Most are hardworking and proud. “Our patients are some of the
nicest people you’d ever meet. They’re down on their luck,” but, she confides,
“sometimes we have trouble getting people to accept help.”
They need the help. Residents in this part of Appalachia experience
disproportionately high rates of heart disease, diabetes, and pulmonary disease.
Some counties report twice the early death rates as the rest of the state. Teresa
spends her days on the move. Responding to the bottomless pit of need, she took
her practice on the road, in the early years driving around in a beat-up old
Winnebago called the Health Wagon. Her patients often had not visited a
medical professional in years. But Teresa welcomed them with open arms and
warm spirit, examined them, listened to their stories, diagnosed their illness, and
prescribed their medication.
She used her questions like a scalpel, short and sharp, to cut to a problem to
identify and try to fix it. She started with open-ended questions to get people
talking and to prompt a description of the problem.
How are you feeling?
What are your symptoms?
How long has it been like this?
Teresa asks her patients about a lot more—their work and their home, their
families and their lives, how they’re eating and what they’re drinking. She
listens for clues pointing to the root of the problem. As she asks, she brings
instinct, experience, and expertise to bear. She’s been practicing since she was
young.
Teresa grew up in this part of the country, in Coeburn, Virginia. She shared a
tiny room with her sister in the trailer that was the family home. Her father
worked in the mines, her mother in a sewing factory. Her dad had a bad back,
and some days the pain was so acute, he would fall out of his truck at the end of
the day and crawl to the front door.
While the family didn’t have much, they had more than many, and they
helped where they could. Her grandmother, “Mamow,” a plump woman who

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lived nearby, opened her home to feed and occasionally house sick neighbors,
some suffering from tuberculosis. Teresa’s mother took meals to the local
hospital. Teresa volunteered at the hospital, too.
A curious child from the time she was little, Teresa peppered her mother
with questions about how things worked, where they came from and why. She
asked about places and people. Her mother nicknamed her “Miss Nosy.” Teresa
took her inquisitive nature to school. She recalls the day her sixth-grade teacher,
Mr. Bates, drew a heart on the blackboard and started explaining how it had
chambers and valves and pushed blood out and through the body. She was
mesmerized and wanted to know more about how the heart worked. How did it
know how much and how fast to pump? She developed an interest in science and
started reading magazines, books, articles—anything she could find about
medicine and biology.
She became the first in her family to go to college and ultimately earned a
doctorate in nursing practice. Then she came home. She wanted to work in the
place where she was raised and where she knew her help was needed.
The Mystery Patient
Trekking across this complex terrain of geography and human need, Teresa
elicits vital information from people who are often reluctant to talk. Her warm
Virginia accent softens her questions, but they are nonetheless deliberate and
focused. Teresa expects a detailed description of what hurts and where. She
seldom wastes time or words. Often the problem is buried deep.
Teresa pulled the Health Wagon into Wise, Virginia, shortly before lunch
one day, and a woman climbed aboard. She was short and overweight and in her
early twenties. As usual, the first question was big and open and warm. With a
smile she asked:
How are you doing today?
Not well, the woman said. Her head hurt. She was feeling tired and weak.
She felt confused, disoriented. Teresa asked about her past health issues. The
woman said she’d suffered from high blood pressure, chronic weight issues, and
diabetes.
Teresa suspected the woman was having a diabetic attack. Her questions
grew more specific and urgent, homing in.

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What medicines are you on? What dosage?
When was your last insulin injection and last meal?
What are your other symptoms?
How long have you had diabetes? Is it Type 1 or Type 2?
When was your last lab work?
What has your insulin regimen been for the past few days?
The answers came in short, hesitant responses. But they added up. A blood
test confirmed it: The patient was suffering from hyperglycemia. The treatment
for diabetes and high blood sugar is straightforward. Strict diet and carb
counting. Insulin, closely monitored. Regular doctor visits. The patient failed on
all counts. She was taking insulin but wasn’t sure of the dose. She hadn’t been to
a doctor in two years. Teresa wanted to know what was going on and why.
“When we talked to her, it wasn’t obvious at first,” Teresa explained. “But